الفهرس 
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Abstract
Many traditional risk factors like smoking, obesity, & hyperlipidemia are related to ACS in younger ages. Nowadays, new markers like hyperhomocysteinemia have emerged in relation with ACS in younger age groups. Moreover, high homocysteine levels have been closely related to severity of ACS.
Homocysteine is sulfur-containing amino acid that has been employed as intermediary in metabolism of methionine but is not found in dietary protein or used for its endogenous production.
Early research indicates that Hcy not only affects endothelial function, creating prothrombotic milieu, but also triggers inflammatory response, speeding up atherosclerosis in cardiovascular illnesses.
There is a direct correlation among homocysteine’s raised fasting plasma levels& many pathological disorders, such as bone health, neurodegenerative disease, renal dysfunction, cognitive impairments, congenital defect development, in addition to its status as an independent risk factor in coronary heart disease & cerebrovascular disease, even though it has been unclear whether homocysteine represents indicator or aetiology of disease.
Additionally, Hcy is indicated to be closely linked to elevated risk of cardiovascular events in studied cases with cardiovascular disease & is regarded as risk factor for existence of atherosclerotic vascular disease& hypercoagulability conditions. Our goal was to ascertain the link among elevated homocysteine levels& greater risk of ACS in individual’s underage of thirty.
This cross-sectional study on 100 patients will be selected among those admitted in internal medicine department and coronary care unit with acute coronary syndrome.
1- studied cases who presented in hospital with chest pain consistent with ACS with any of following features: a- Electrocardiogram changes, ST elevation, ST depression, T wave inversion, recent left bundle branch block, b- Troponin T elevation (Normal value < 0.06) 1-The studied cases who presented in hospital with chest pain consistent with ACS with any of following features : a- Electrocardiogram changes, ST elevation, ST depression, T wave inversion, recent left bundle branch block, b- Troponin T elevation (Normal value < 0.06).
. 2-Age: a- among eighteen- forty (group A) b - > forty years (group B)
• Most cases in group A (66% cases) & in group B (70% cases) had high homocysteine level. The mean homocysteine in group A & group B was 22.06± 9.84 µmol/L and 22.96± 11.06 µmol/L respectively. There were no variations among 2 studied groups regarding homocysteine level (p>0.05)
• In group A, there had been positive correlation among homocysteine level with triglycerides (r=0.310, p=0.028), but there was negative relationship among homocysteine level ratio with HDL (r=-0.340, p=0.016).
• In group B, there had been negative relationship among homocysteine level ratio with systolic blood pressure (r=-0.309, p=0.029) &diastolic blood pressure (r=-0.309, p=0.029).
CONCLUSION
We concluded that there was insignificant difference between young and old age as regard homocysteine level. There was positive relationship among homocysteine level with triglycerides, while there had been negative connection among homocysteine level ratio with HDL in young age, while there had been negative connection among homocysteine level ratio with systolic blood pressure& diastolic blood pressure in old age.
Any studied case presenting with acute coronary syndrome could not have any of the traditional risk factors for atherosclerosis, such as diabetes mellitus, hypertension, smoking, & dyslipidemia. Consideration of the existence of novel risk factors, such as elevated serum homocysteine, must be given, especially in young individuals, as a significant contributor to atherosclerosis and coronary artery disease.
Limitations
• Our sample size & number of events had been limited.
• This research is a single center research.
RECOMMENDATIONS
• Further clinical studies are needed with multicenter cooperation to validate our findings.
• Future clinical studies are needed with larger cohort.
• Future clinical studies are needed for longer follow up.
• Even in the absence of a vitamin deficiency, folic acid& vitamin B6 can reduce high homocysteine levels. However, further study is necessary to define impact of therapy with these vitamins& vitamins B12 on cardiovascular disease in both middle-aged& elderly people.
• Further studies are needed to identify correlation among mortality & High homocysteine levels.